Cognitive Pearl #036 Shevat 1, 5775 January 21, 15

When we speak about the cognitive approach to neutralizing obsessions and compulsions we’re focusing on two dimensions. The first dimension includes the thought dimension of the obsession and the compulsion that traps the client. This is the ‘story’ that the client tells himself is the source of his troubles. The second dimension, which is usually the most fruitful target for intervention, includes the thoughts and beliefs that the client has about the experience of anxiety.

Here’s an example: A sixty year old male seeks treatment because he spends many hours every evening checking to make sure that the front door to his apartment is locked. He’s aware that this amount of checking is excessive ‘BUT’ (that’s a word you hear a lot in this business).

‘But what?’I ask.

‘But maybe this and maybe that and maybe something else’, he answers.

All of these worries constitute what I call the first dimension. We can invest session time in neutralizing these worries. Together we can review each of these interlocking beliefs and determine which are useful and which aren’t. (Please notice that I’ve introduced the ‘usefulness’ into the discussion. More on that later.)

This exploratory process is a very important part of the work. However it’s irrelevant if the second dimension isn’t addressed: the cognitions around fear. It’s those cognitions that prevent our clients, perfectly intelligent and full of robust executive function abilities, from cutting through their obsessions like a hot knife through cold butter.